Suicide: A Grey Old Springtime

6. June 2017

Share article

It's already a well known fact that winter and the darkness it brings with it dampens one's spirits. The surprising thing is that patients with depression often find it particularly difficult to deal with springtime. The suicide rate is then also elevated. Biological and psychosocial factors play a role here.

Many are familiar with the matter: bleak and cold winter days batter one’s mood, whereas the springtime sun and nature’s revitalisation lead to a better mood and to an urge to be active. “Winter depression” has for many people even become a distinct concept: tiredness, a lack of energy, a despondent mood and anxiety, occurring first and foremost during winter months. The fact that some depressive patients have difficulty with the very beginning of the warmer season is in contrast less well known. Nevertheless studies show that the intensity of depressive symptoms and the number of suicides reach their peak in the spring – in the northern hemisphere in April and May, in the southern hemisphere in November and December. This is particularly the case for men and older people; more violent forms of suicide see a rise in incidence as well.

There exists a tight correlation between severe depression and suicide: 90 percent of suicides stem from a psychiatric disorder, most commonly depression. Half of all people with depression make at least one attempt to end their lives; some fifteen percent with severe depression actually take their lives.

A series of factors as subject of discussion

There is a whole series of factors being discussed which might explain the correlation between spring and the severity of depression”, says Gernot Langs, head physician at Schön Klinik in Bad Bramstedt (Germany). “This includes for instance biochemical factors which coincide with the condition, as well as seasonal, genetic and psychosocial factors. Clearly many things come together in May which can, and often do, lead to a distinct increase in depressive symptoms”.

Studies have shown as such that the elevated suicide rate in spring could correlate to higher temperatures or to the number of sunshine hours – other studies however have not found this at all. What’s more further seasonally defined factors such as day length, light intensity and the frequency of pathogens or allergens can contribute to this association.

In addition, it is assumed that aside from seasonal and affective disorder (SAD) during the autumn or winter months (typical “winter depression”) a form of seasonal affective disorder exists which occurs mainly in the spring and summer months. According to the National Alliance On Mental Illness about every tenth SAD sufferer suffers from this form of depression.

Serotonin transporter could play a role

An recent study indicates that a modified binding capacity for serotonin transporter (SERT) in the spring and summer could be related to the increased suicide rate and an increase in depressive symptoms at this time of the year. Already in earlier studies a lower binding capacity for SERT was ascertained among suicide victims and survivors of suicide attempts.

Researchers led by Georgios D. Makris of Uppsala University in Sweden have now investigated what influence starting to take an antidepressant medication at a given time of the year has on the number of suicide attempts. They found that those over 65 years of age had a higher risk of suicidal behaviour when they started taking antidepressant medication in spring or summer. This effect was not found with young patients (up to 24 years of age).

So far it is known that selective serotonin-reuptake inhibitors (SSRI) act on the serotonin receptors in the brain in such a way that the antidepressant effect works with a delay, and it may initially even deteriorate. This effect might even be amplified by the lower SERT binding capacity in the spring, Makris and his team suggest.

“Overall, many assumptions exist about the severity of depression and the season, but inconsistent results exist as well”, Langs summarises. “In the end, we do not exactly know which factors contribute to the increased suicide rate in the spring, and why it is worse for many depression sufferers in this season”. In any case, the starting point for taking an antidepressant medication should not be dependent on the season, according to the researcher. Instead, the effect of the medication should be closely monitored – for example, as to whether there is an increase in drive in activity, but the mood still does not improve. “If desired, the SSRI can be supplemented with benzodiazepine or a base neuroleptic until the mood brightens”, Langs says.

Also of importance: dampened expectations

However it’s not only biological, but also psychosocial factors that can play an important role in the deterioration of depressive symptoms in the spring. “Many affected people have the expectation at this time: when the sun once again shines and the days become longer, things will be better for me as well”, Langs explains. “Yet on the contrary many moods intensify: the higher the expectations, the greater the disappointment”.

Moreover making comparison with other people around us can strain our mood. “When a depressed person observes that during spring most people are in good spirits and they are bursting with activity, this can make him or her feel worse”, the specialist in psychosomatic medicine and psychotherapy says.

Regardless of why deterioration occurs: whenever a person experiences depressive symptoms during spring, or these symptoms increase significantly during this season, he or she should consult a doctor or psychotherapist, Langs emphasises. As a treating physician one should again be aware that it is not uncommon for depression to deteriorate in the spring, he says.

It is helpful for the patients to know the interconnections and to obtain sufficient information about their illness. “They should come to know that things will not necessarily be better for them with the arrival of good weather”, says Langs. “In addition, they should be aware that the changing of the seasons can burden their bodies. They ought to grant themselves the time and the freedom to make this switch-over”.

Asking instead of giving advice

It is also important to convey to family and friends that they should refrain from well-meaning comments and advice. “One should avoid phrases such as ‘When the sun shines again, you will quickly feel better’ or ‘How can you be sad in this weather?’. These only exert unnecessary pressure on the depressed person’s family”, explains Langs. “Instead, they should ask what he or she needs, or what would do him or her good”.

In the end, not everyone with a depression suffers a turn for the worse in the spring – some perhaps tend to experience a critical phase in summer or around Christmas. “It is therefore important to look at each patient individually – to look at what he or she needs and how to best support the patient”, according to Langs.